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The Abbreviated Life of an Initiative

Posted by J. Paul Spencer, CPC, CPC-H in Hot Topics

I’d like to start today’s rumination with some equations based on life span and time. I beg the reader to stay with me as I do some quick calculations.

The common house fly has an average life span of 15 to 30 days. As of today, I have been alive for 16,500 days on this planet (yes, I count them; my last fatalistic thread hanging on for dear life). The average life span of a male in America is roughly 75, so if I was a fly with a maximum life span, I would be roughly 20 days old right now.

Now given that I am 16,500 days old, that would mean that if we broke up a human life into 30 segments, with each segment equal to 1 day in the life of a fly, we come to the point where each human-fly segment is equal to roughly 825 days in real time. As well as being an appealing mathematical exercise, this becomes a great way to transistorize your own past. As an example, if I were a fly, my first marriage would have only lasted for about a day and a half. If only……….

In the world of health care this week, we had a further demonstration of the brevity of a lifespan. In the  New York Times on Sunday, June 26th, there was a story regarding a CMS initiative to send out “mystery shoppers” to gage the simplicity of getting an appointment with a doctor. The article was based on a proposed rule that was released by CMS close to two months ago for public comment.

The study was to include a series of three telephone calls by “patients” to 4,185 physician offices in 9 states. The first of these calls would have been from someone posing as a patient that has commercial insurance attempting to get an appointment. The second call would have been from someone with the same medical problem as the first, but with a government insurance plan. The third call was to be from someone who clearly identified themselves as being from the Department of Health and Human Services, with the person asking what type of insurances the office accepts. At the conclusion of the call cycle, the answers would have been compared, with the goal being a determination of what percentage of physicians perhaps discriminate due to type of coverage.

I used the past tense in the above paragraph because this initiative was scrapped by CMS on Tuesday. That’s roughly 48 hours from the pages of The Gray Lady to the cemetery, a time frame envious of your average house fly.

The present day is a lousy time to be a primary care physician. Currently, there stands in the American health care system a dire shortage of internal medicine and family practice physicians. If the Patient Protection and Affordable Care Act stands as written (and the 6th Circuit Court of Appeals ruled that it should this week), there will be a population of over 40 million people suddenly insured through a combination of expansion of Medicaid and new or established state exchanges, and every one of them will suddenly have a desire for a doctor’s appointment. This will be in addition to the patient volume already experienced by front-line providers, who on average spend a paltry 12 minutes with their patients during a visit. Given that the new population will be under penurious government fee schedules, you can excuse providers for their lack of excitement about the Affordable Care Act.

As if this most obvious of challenges isn’t enough, expanded audits by multiple independent contractors will soon pose a direct threat to the monetary health of the practice. With CMS’ announcement of the addition of predictive modeling technology being added into the mix, physicians are now financially at risk both prior to and after claim payment being received, making it virtually impossible to draw up a budget for a medical practice. 

With all of this as a backdrop, there was quite a bit of blow-back to the “mystery shopper” proposal, with criticisms of ”over-regulation” and “government spying” increasing in volume as comments were submitted. This was in spite of the fact that CMS guaranteed that the collected data from the survey would have remained confidential.

Thus we conclude this week’s abject lesson in abbreviated life spans. As I face the last ten fly-days of my life, it is with the knowledge that some flies, as well as an assortment of government initiatives, have shorter existences than others. Enjoy it while you can.